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Cover page of the Journal of Health Sciences


 
 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 306-308

A battery where it should not be


Department of ENT and HNS, J. N. Medical College, KAHER, Belagavi, Karnataka, India

Date of Submission06-Feb-2022
Date of Acceptance25-Apr-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. Mansi A R. Venkatramanan
610, New PG Hostel, J. N. Medical College Campus, KAHER, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_123_22

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  Abstract 


The shiny and attractive nature of objects such as button batteries or coins draws children toward them. It is vital to correctly identify such foreign bodies and promptly remove them without causing any fragmentation or damage as that may cause the electrolyte within the battery to leak and further corrode the mucosa. Here, we present the case of a 5-year-old girl referred from a community hospital with a foreign object in the nose and how it was managed in a timely and successful manner.

Keywords: Alkali, battery, button, foreign body, nasal cavity


How to cite this article:
Harugop AS, Venkatramanan MA, Goswami L, Nayak S P. A battery where it should not be. Indian J Health Sci Biomed Res 2022;15:306-8

How to cite this URL:
Harugop AS, Venkatramanan MA, Goswami L, Nayak S P. A battery where it should not be. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:306-8. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/306/356261




  Introduction Top


Small objects such as button batteries, seeds, small stones, coins, and pieces of food particles are becoming common objects that children place in their nose/ears. Nasal cavity foreign bodies are usually unnoticed unless the patient develops symptoms such as pain or foul-smelling discharge. Button batteries pose several risks such as tissue damage due to spontaneous electrolyte leakage, corrosive effects, pressure necrosis, and electric burns due to electric currents generated.


  Case Report Top


A 5-year-old girl child presented with complaints of pain in the nose for 6 h. Her parents suspected that she put some small objects into her nose while playing with her friends in the morning. The pain was insidious in onset, gradually progressive, continuous, and nonradiating type. The patient was otherwise normal and achieved all developmental milestones. They initially took the child to a community hospital where an X-ray of the nose, lateral view was done and a round radiopaque foreign object was seen in the left nasal cavity [Figure 1]. She was then rushed to our hospital for further management and foreign body removal. On examination, a shiny, metallic foreign body was identified in the left nasal cavity between the middle turbinate and the septum. The mucosa of the left nasal cavity was congested with mucoid discharge present. There was tenderness on palpating the dorsum of the left side of the nose. She was immediately admitted and taken up for foreign body removal under IV sedation in an operative setup. Under endoscopic visualization, a shiny metal object was visualized that most likely was a button battery, lodged between the septum and the middle turbinate of the left nasal cavity [Figure 2] that was successfully removed [Figure 3]. There was no bleeding, and the child tolerated the procedure well. A nasal pack was placed for a few hours and was removed. She was kept for observation for 24 h where she was given intravenous antibiotics to prevent any possible infection. She was discharged after a day and was told to follow up after a week.
Figure 1: A round radiopaque object (shown by the red arrow) in the anterior part of the nasal cavity seen in X-ray

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Figure 2: Endoscopic view of the left nasal cavity showing a metallic object (shown by the red arrow) lodged between the septum (s) and MT. MT: Middle turbinate

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Figure 3: The foreign body – button battery was removed in toto as shown

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  Discussion Top


Children are curious in nature and want to experiment with the environment around them. They commonly put small objects such as small beads, button batteries, small rocks, beans, cotton from earbuds, coins, etc., into their nose, ears or may swallow it or sometimes worse, aspirate it. Viji et al. stressed about how child care providers need to be informed of the hazard of these button batteries and about the prevention of such incidents. Hence it is important in creating awareness about the hazards associated with battery exposure among parents is vital and prevention is the most effective treatment strategy in such cases.[1] The first reported case of a button battery foreign body was in 1977 and involved a child who swallowed a camera battery which lodged in the proximal esophagus.[2],[3] Mechanisms of injury by these batteries to the mucosa have been proposed by Litovitz (1986):[4] (1) spontaneous electrolyte leakage, with liquefaction necrosis and cumulative tissue damage; (2) corrosive effects of mercury oxide after leakage; (3) pressure necrosis from the impacted foreign body; (4) electric current generation causing electric burn; and (5) there is some evidence that the use of saline nasal drops or vasoconstrictors may provide electrolytes[4] that produce chlorine gas and sodium hydroxide resulting in further necrosis.[5] Hence, the use of such drops must be strictly avoided. Foreign bodies lodged into natural orifices of the head and neck are commonly encountered in ENT clinic and in the emergency room, and most of these cases belong to the pediatric age group. Taking a detailed history and doing a quick and thorough physical examination is very important. Active ENT intervention such as taking up for operative procedure or debridement must be decided promptly. In this case report, we focused on a button battery in the nose of a toddler of acute onset and how it was quickly intervened and the child was saved from serious complications. Dane et al. in a similar study emphasized the serious orbital and otologic complications in a case where a button battery was lodged in the nose.[5]

A case series by Zanetta et al. stressed about how button batteries deserve particular interest due to the severity and precocity of the injuries they cause such as septal perforation.[6] Button cell causing septal perforation in a child was a case report by Bhatia et al. that emphasized the hazards of button battery impaction and the value of early diagnosis and treatment to prevent serious complications.[7] It is important to create awareness among parents about the hazards associated with battery exposure and stress on the fact that prevention is the most effective treatment strategy in such cases.[8]


  Conclusion Top


The shiny and attractive nature of objects such as button batteries draws children toward them. An important differential diagnosis to button batteries is coins that children commonly put into the nose. The use of decongestants with the foreign body in situ poses a risk for further complications such as necrosis from electrolytes in the foreign body slipping further deep into the nasal cavity making their removal even more difficult or worse and slipping into the nasopharynx from where it may be aspirated or ingested. It is vital to correctly identify such foreign bodies and promptly remove them without causing any fragmentation or damage to the button battery since that may cause the electrolyte within it to leak and further complicate the condition.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Viji R, Nadarajah S. The hazards of impacted alkaline battery in the nose. J Fam Med Prim Care 2018;7: 1083.  Back to cited text no. 1
    
2.
Blatnik DS, Toohill RJ, Lehman RH. Fatal complication from an alkaline battery foreign body in the esophagus. Ann Otol Rhinol Laryngol 1977;86:611-5.  Back to cited text no. 2
    
3.
Lin VY, Daniel SJ, Papsin BC. Button batteries in the ear, nose and upper aerodigestive tract. Int J Pediatr Otorhinolaryngol 2004;68:473-9.  Back to cited text no. 3
    
4.
Kavanagh KT, Litovitz T. Miniature battery foreign bodies in auditory and nasal cavities. JAMA 1986;255:1470-2.  Back to cited text no. 4
    
5.
Dane S, Smally AJ, Peredy TR. A truly emergent problem: Button battery in the nose. Acad Emerg Med 2000;7:204-6.  Back to cited text no. 5
    
6.
Zanetta A, Cuestas G, Rodríguez H, Quiroga V. Perforación septal en niños debido a pila botón alojada en nariz: serie de casos [Septal perforation in children due to button battery lodged in the nose: case series]. Arch Argent Pediatr 2012;110:430-4.  Back to cited text no. 6
    
7.
Bhatia R, Singhal SK, Dass A. Button cell causing septal perforation in a child. Clin Rhinol 2010;3:161-3.  Back to cited text no. 7
    
8.
Thabet M, Basha W, Askar S. Button battery Foreign bodies in children: Hazards, management, and recommendations. BioMed Research International Egypt 2013;2013:1-7.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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